Journal of Neuro-Oncology

, Volume 112, Issue 1, pp 83–89 | Cite as

Temozolomide use in adult patients with gliosarcoma: an evolving clinical practice

  • Gary V. Walker
  • Mark R. Gilbert
  • Sujit S. Prabhu
  • Paul D. Brown
  • Mary Frances McAleer
Clinical Study


The purpose of this study is to determine the factors that impact overall survival (OS) in adult patients with gliosarcoma in the modern era treated at a single institution compared with a cohort from the SEER registry. A total of 46 adult patients with pathologically confirmed gliosarcoma at MD Anderson Cancer Center from 2000 to 2010 were retrospectively analyzed. Demographic and treatment were obtained. For comparison, a total of 218 patients with gliosarcoma in the SEER database from 1991 to 2008 were analyzed. Survival analysis was conducted using the Kaplan–Meier log rank test. At MD Anderson, the overall incidence of gliosarcoma over the specified time interval was 1.5 %. Gliosarcoma was more common in males (n = 31, 67.4 %) with a median age of 56 years (range 24–92 years). Median survival in all patients was 12.5 months. A total of 17 patients (37 %) received temozolomide (TMZ) concurrently with RT and adjuvantly, with a 24 month OS of 20.0 %, compared with 10.2 % among those not treated with this regimen (p = 0.68). In contrast, the 2 year OS rate in the SEER database was 24.2 % during 2006–2008, compared to 12.1 % among those diagnosed in 2000–2003 (p = 0.03), presumably related to the widespread adoption of the chemoradiation regimen. Patients with gliosarcoma treated with TMZ at a single institution improved OS although this finding did not reach statistical significance. Patients diagnosed in the TMZ era in the SEER database display an improved OS, although the explanation for this finding requires further elucidation.


Gliosarcoma Radiation therapy Temozolomide SEER 


  1. 1.
    Miller CR, Perry A (2007) Glioblastoma. Arch Pathol Lab Med 131(3):397–406PubMedGoogle Scholar
  2. 2.
    Galanis E, Buckner JC, Dinapoli RP, Scheithauer BW, Jenkins RB, Wang CH et al (1998) Clinical outcome of gliosarcoma compared with glioblastoma multiforme: north central cancer treatment group results. J Neurosurg 89(3):425–430PubMedCrossRefGoogle Scholar
  3. 3.
    Kozak KR, Mahadevan A, Moody JS (2009) Adult gliosarcoma: epidemiology, natural history, and factors associated with outcome. Neuro Oncol 11(2):183–191PubMedCrossRefGoogle Scholar
  4. 4.
    Lutterbach J, Guttenberger R, Pagenstecher A (2001) Gliosarcoma: a clinical study. Radiother Oncol 61(1):57–64PubMedCrossRefGoogle Scholar
  5. 5.
    Walker GV, Li J, Mahajan A, McAleer MF, de Groot JF, Azeem SS, Brown PD (2012) Decreasing radiation therapy utilization in adult patients with glioblastoma multiforme: a population-based analysis. Cancer 118(18):4538–4544PubMedCrossRefGoogle Scholar
  6. 6.
    Keime-Guibert F, Chinot O, Taillandier L, Cartalat-Carel S, Frenay M, Kantor G et al (2007) Radiotherapy for glioblastoma in the elderly. N Engl J Med 356(15):1527–1535PubMedCrossRefGoogle Scholar
  7. 7.
    Walker MD, Alexander E Jr, Hunt WE, MacCarty CS, Mahaley MS Jr, Mealey J Jr et al (1978) Evaluation of BCNU and/or radiotherapy in the treatment of anaplastic gliomas. A cooperative clinical trial. J Neurosurg 49(3):333–343PubMedCrossRefGoogle Scholar
  8. 8.
    Kristiansen K, Hagen S, Kollevold T, Torvik A, Holme I, Nesbakken R et al (1981) Combined modality therapy of operated astrocytomas grade III and IV. Confirmation of the value of postoperative irradiation and lack of potentiation of bleomycin on survival time: a prospective multicenter trial of the scandinavian glioblastoma study group. Cancer 47(4):649–652PubMedCrossRefGoogle Scholar
  9. 9.
    Stupp R, Mason WP, van den Bent MJ, Weller M, Fisher B, Taphoorn MJ et al (2005) Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med 352(10):987–996PubMedCrossRefGoogle Scholar
  10. 10.
    National comprehensive cancer network clinical practice guidelines in oncology, central nervous system cancers v.2.2011 [Internet].; cited 2/17/2012]. Available from:
  11. 11.
    Zippin C, Lum D, Hankey BF (1995) Completeness of hospital cancer case reporting from the SEER program of the national cancer institute. Cancer 76(11):2343–2350PubMedCrossRefGoogle Scholar
  12. 12.
    Surveillance, epidemiology and end results (SEER) program [Internet]. Available from:
  13. 13.
    Surveillance, epidemiology, and end results (SEER) program SEER*Stat database: Incidence - SEER 17 regs limited-use + hurricane katrina impacted louisiana cases, nov 2008 sub (1973-2006 varying) - linked to county attributes - total U.S., 1969-2006 counties, national cancer institute, DCCPS, surveillance research program, cancer statistics branch, released April 2009, based on the November 2008 submissionGoogle Scholar
  14. 14.
    Housman DM, Decker RH, Wilson LD (2007) Regarding adjuvant radiation therapy in merkel cell carcinoma: selection bias and its affect on overall survival. J Clin Oncol 25(28):4503–4504 author reply 4504–4505PubMedCrossRefGoogle Scholar
  15. 15.
    Zhang BY, Chen H, Geng DY, Yin B, Li YX, Zhong P et al (2011) Computed tomography and magnetic resonance features of gliosarcoma: a study of 54 cases. J Comput Assist Tomogr 35(6):667–673PubMedCrossRefGoogle Scholar
  16. 16.
    Lee D, Kang SY, Suh YL, Jeong JY, Lee JI, Nam DH (2012) Clinicopathologic and genomic features of gliosarcomas. J Neurooncol 107(3):643–650PubMedCrossRefGoogle Scholar
  17. 17.
    Stupp R, Hegi ME, Mason WP, van den Bent MJ, Taphoorn MJ, Janzer RC et al (2009) Effects of radiotherapy with concomitant and adjuvant temozolomide versus radiotherapy alone on survival in glioblastoma in a randomised phase III study: 5 year analysis of the EORTC-NCIC trial. Lancet Oncol 10(5):459–466PubMedCrossRefGoogle Scholar
  18. 18.
    Han SJ, Yang I, Ahn BJ, Otero JJ, Tihan T, McDermott MW et al (2010) Clinical characteristics and outcomes for a modern series of primary gliosarcoma patients. Cancer 116(5):1358–1366PubMedCrossRefGoogle Scholar
  19. 19.
    Han SJ, Yang I, Tihan T, Chang SM, Parsa AT (2010) Secondary gliosarcoma: a review of clinical features and pathological diagnosis. J Neurosurg 112(1):26–32PubMedCrossRefGoogle Scholar
  20. 20.
    Han SJ, Yang I, Otero JJ, Ahn BJ, Tihan T, McDermott MW et al (2010) Secondary gliosarcoma after diagnosis of glioblastoma: clinical experience with 30 consecutive patients. J Neurosurg 112(5):990–996PubMedCrossRefGoogle Scholar
  21. 21.
    Mason WP, Cairncross JG (2005) Drug insight: temozolomide as a treatment for malignant glioma—impact of a recent trial. Nat Clin Pract Neurol 1(2):88–95PubMedCrossRefGoogle Scholar
  22. 22.
    Cohen MH, Johnson JR, Pazdur R (2005) Food and drug administration drug approval summary: temozolomide plus radiation therapy for the treatment of newly diagnosed glioblastoma multiforme. Clin Cancer Res 11(19 Pt 1):6767–6771PubMedCrossRefGoogle Scholar
  23. 23.
    Darefsky AS, King JT Jr, Dubrow R (2011) Adult glioblastoma multiforme survival in the temozolomide era: a population-based analysis of surveillance, epidemiology, and end results registries. Cancer 118(8):2163–2172PubMedCrossRefGoogle Scholar
  24. 24.
    Johnson DR, O’Neill BP (2011) Glioblastoma survival in the united states before and during the temozolomide era. J Neurooncol 107(2):359–364PubMedCrossRefGoogle Scholar
  25. 25.
    Stummer W, Pichlmeier U, Meinel T, Wiestler OD, Zanella F, Reulen HJ et al (2006) Fluorescence-guided surgery with 5-aminolevulinic acid for resection of malignant glioma: a randomised controlled multicentre phase III trial. Lancet Oncol 7(5):392–401PubMedCrossRefGoogle Scholar
  26. 26.
    Salvati M, Caroli E, Raco A, Giangaspero F, Delfini R, Ferrante L (2005) Gliosarcomas: analysis of 11 cases do two subtypes exist? J Neurooncol 74(1):59–63PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  • Gary V. Walker
    • 1
  • Mark R. Gilbert
    • 2
  • Sujit S. Prabhu
    • 3
  • Paul D. Brown
    • 1
    • 4
  • Mary Frances McAleer
    • 1
  1. 1.Department of Radiation OncologyThe University of Texas M. D. Anderson Cancer CenterHoustonUSA
  2. 2.Department of Neuro-OncologyThe University of Texas M. D. Anderson Cancer CenterHoustonUSA
  3. 3.Department of NeurosurgeryThe University of Texas M. D. Anderson Cancer CenterHoustonUSA
  4. 4.Department of Radiation OncologyMayo ClinicRochesterUSA

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